HomeMy WebLinkAboutBuilding Permit # 9/23/2015 RT
BUILDING PERMIT o�""D "pyo
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION ® - _ »
Permit No#: Date Received TED
Date Issued: °fit
IMPORTANT:Applicant must complete all items on this page
LOCATION -)VUAA)J. "Ityi%1Z.
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Print ti
PROPERTY OWNER P C r,�- (LQ
C .„ " Print 100 Year Structure ngL,„"
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes tao
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building ❑ One family
[�Addition ❑Two or more family ❑ Industrial
[J Alteration No. of units: ❑ Commercial
['7 Repair, replacement ❑Assessory Bldg ❑ Others:
[; Demolition ❑ Other
Nam„ , „ r ,<,.:.rik
,,, .i.,,r�';r J,. .,.J. .,, ,l ,,�� .// //, ,,...,” ..v , . /r, ,, ,.,(/ ,/ ,.,. n ,/ i, ��ir �k e s' e ,D is,etlamds , at r h d, tr tli , 1, .,.. ,..,,� ,� �.,,.,. }rr, ,- � /� o/rr ,� , � Jli2 f� l l„ , „���',� ; ��IrJo 1, �.F � ,'!)Ji��� 1t�� �'%1. �11G1(N� ,r✓'ri
DESCRIPTION OF WORK TO BE PERFORMED:
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Location t,� � ��.��rm � � � �.�. �',a
Date .
ddre�s: ? No. 71 Its �
,Jontr;4ctor Name 3(.Z”
mail: _ TOWN OF NORTH ANDOVER
Addreps
Certificate of Occupancy V
supervisor's Construction Licer� a Permit Fee °b�� ' ���
Building/Frame
Flornp Improvement License:—i Foundation Permit Fee
Other Permit Fee
ARCHITECT/ENGINEER TOTAL
Ad'dfess:
FEE SCHEDULE:BULDING PERMIT:$9i; Check#�����
Totell (Project Cost: $ Building inspector
Check No.:
_... .
NOTE: Persons contracting with�� ed coni ctors �do not have access to t1 a and
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O�QA COCNIC!WICK
04ATED 01 fp
S UMEML
BOARD OF HEALTH
Food/Kitchen
PERMI T LU Septic System
THIS CERTIFIES THAT .. ................ ...... BUILDING INSPECTOR
......................... .... ........ ............ ....... ..... ...
%004
..................... Foundation
has permission to erect .......................... buildings on . . ........iA&A.1111.......... .
04, ® Rough
Q _
to be occupied as ........... ... .... ... np �ii
...... .......1 ... ..T. ........ ................................ Chimney
provided that the person accepting this permitevery respect conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR
CONSTRUCTIONUNLESS STARTS Rough
Service
................... ..... ..�::n�� 1 1� .�:::......................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required t® Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
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8 '
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Estimate
pending resolution OfHealth O[ Safety Issues
Next 0e ("N L")
W1ichae| Grenier 21DwduukAvenue,2nd floor
Boston, MA 02210
�2 Ha[kevvayRd phone: �6' 807872e
North Andover, PWAO184S
Site U: 411917 �
12-Jun-15
1. DESCRIPTION OF WORK TO BE PERFORMED �
NSL will perform or cause to be performed the following work on the customer's address above, in a professional manner and in accordance
with the terms of this Contract,including the uuocxau recommendations/work order describing the work in detail(the"Work")wm/on are �
incorporated herein reference. Pricing reflected below may be subject to adjustments in program pricing and offerings and is guaranteed
for 3Odays from the date the Contract|nprinted.
�
�
Work Location: Attic Flat
Perform Air Sealing mtEstimated 62.5CFK4G0PerHour G $8500 Hr $51000
VVorhLoouUon: Attic Flat
Re[daoaBo#hFanHomo i $50.00 Each $50.00
Hatch: Thermal Barrier Po|yiso2inch (At(ic) 1 $00.00 Each $60.00
Damming 42 $2.05 LnM $86.10 |
Propavani2'or4' 16 *2.00 Each *32.00
Attic Floor OBlow Cellulose 7" 515 $130 m h $60950
Work Location. Slope
Attic Slope Int Danompauk8" 84 *2.00 oqh $168.00
Attici Enclosed CU | Dense Pack 6" 72 $1.86 sqft $133.92
VVorkLocoUonv VVaU �
Insulate Vinyl Sided Wall With 4"Dense Pack Cellulose 851 $1.85 eqh $1.574.35
1DU96AinSemUngIncentive LIP b) Program Max $510.00 �
7596VVeaiherizaMonIncentive uptVProgram Max $2.000.08
Estimated Annual Energy Savings from the Above Improvements $298.00
Nrchaef��ren�er(Jul 2,2015) Jul 2' 2015
Customer Signature Date
jUD1�. �O1� /\O�[�VVT[BVi8
�u.�
NSLSignature Date Name ofNSLRepresentative A770374
The Terms ofthis Agreement are contained noboth sides of this page
Next Step Living-21 Drydock Avenue 2nd floor-Boston,MA 02210-(866)867-8729-inquiry@nextsteplivinginc.com-
TERMS OF AGREEMENT
3.PROPOSED START DATE AND COMPLETION SCHEDULE
NSL wd contact oistma to a&?&the A a Gu; M aWwA time,aged to Me x6hWil of sun or a makiali or to 65"ribWlablo W Te
weaker or oMw News beyand NSQ cm10
4.CONTRACTOR REGISTRATION
Nbwa&WN Aw rumms home hufmovement(mr1achs and whcmhodas a A mytered nM Me iJrector or cleanse InWoveivent Corlkadx flegsTration Ycu may
iEtwe abuit 4 wilty 0 Offlive dConsumer Affairs and Business Regulation,Ten Park Plaza,Suite 0170,Boston,MA 02116.617.973.8700
5.PERMITS
NS[ vlilloblp'iln my necessaiy pumlits as the Cu mn's Men[ Cobnem No wcum Mak own punts or had wit an uni-eystared contractor All be exxtWod from the
Gummy Fund povinns of Me If=Qrweamin!CmVuham.,j.
6.PERFORMANCE OF THE WORK AND CHANGES.
6 1 Na wMmL cornmence the Work prim-0 QN this Npermnt w!"nsmial of a copy of Agmemed to Me Customs
61 tsAysernent maybe sufnilemenra meta u-mothhecl only by the,nilual agmarml of flit,pmks.No a mo6kalim M[lois
Agreement Wd be binding miss itis An wXy and sigied by all parties_
13 Attimms, own dimovanssituations in the 2huduedump Me course dMeMork Haat hilvissa ilk Kra MAM or safety
Such can�. :uas can include Lut are nog hrud:,d to ventilation pot�_r,tiall� aazard{:,!r,�i aot�rial,sacl�as n}olCi or asb tos ccr stn.rchrrel tic ice ins. Ir fra:<ese a I,,rile Oi
safety concerns being Wenhhel AShesaves Me Qhl,per section 12 A IN cminaU W communicate concerns to Me Cusknmer and IN wmk m1R such corworris have
been addressed,
14 no HaN and Amhes aNWA from Me Wm SuR Hon s Soly SmOvAlogralis and amounts due born the%Wmei we based on the bet ushinde of
to Antihlhthe AlwWre by the NSL home anergy achawr 11wever at times aurwed-iorhation ten-n disco vers Atunkris in he Mom SAM He course 4Mo Work
khat Iran Me mWATIdWates and AmWesfrom Me Was Sam grogram.
impad on amount Me Custo mer would be eVeded W pay far it VO4 1 M Dislorox Anam be When to own Rom Me uWac"M work dements ME need
adynnea a SO W a spate crowuld for per ionising the a4issiWork.
6.5 NSI iepies'enband vial faits to be Custom r that(Q Me makkk and equipmall lumd-ad under IN AWeemarrt wMw or WWI TM4 and new,M that M"ki k
.til{ben.e front ueru,t.>,anis(,)flat J d, JJ�i<will conform;with fh('do sGl;)doll of the tl9ori.fc.�criusd rn i 3idgi app'f.
7.INSURANCE AND REGISTRATION
NTAymah end mirmh W the Cushma that R has a WH Home Ammmment Contractor Regishafion(i'\b: i6211 if end he necessary insurance iquirct by
,a
pplicalble lavi;-ind nounally irlmnlained by prudent mWadors in NSL`s Add AlchAnq WAN bled A Vkkrs Carntansdon houranm for all emoopes who will
PNfryin the woik.
8.QUALITY OF WORK.
NU age,ME the Wmk Ad be performed in a goad and wokmanile wartier,and ME N1.At repair and mone,A it,own expense,and promptly Mori Cudonlei's
equest.any defects in and mahrials poWed by NSL whwh appeal q to(0 yaw after cornplelion of the Work or wiMA any buyer prood as perindlod or
required under applicable law,provided NS1-has mceived finail payment as piovided herein.
9.PRE-EXISTING CONDITIONS&PROPERTY PROTECTION
S.1 NSI. shall not pe responsilsle for eery aarnages as&consegucnce of the tAaork raerfcimrc� n toe ilonae due ko p e.,xistiug ccancfilkms J f ;�e conditions include ixit are
not HANd M poily fabened or Raw IpJ,moildute dannage,nor,,code con sArudron.slacked o"ffaBile sidinc orshingles,old pipes and Afflings,robing wood,ote,
91 NSL moon the Not not W peAn VMk Won Me Iscomy of asbastay mall or an Als W the Customer. A this menT the Customer is
responsible for remedying the OVA Sidon KAQ any Mmury removal omaammn;malar rats and all Ws for septic es to date shalt be paid ininnhately. Work
Cannot resume until I ernediation is Complete,
91 With RL Allimilke but dfu N to paid any property of the Customer, R K the%mmert revonsibmy W mmme or proku including OW protection,any
person property including(h?home itself NSLwA not tae responsible for damages W or bum dany dtine Awe mentioned pqmQ nest property Prot eked pwto he
co mmoncement W we Mork.
jO.GENERAL PROVISIONS.
It! AShesswes Me 4M, Me extent pankled by applicable We W have.Me or mambn a me6mks a noted mu's hen,m to Me a noke ohnhtorr W hen,aid
to fake my other steps W pi reek and enforce such Hen,if Datums-fals to pay OL as provided herein.
101 AN Agmmwnt shall e mWmal A accord nce Win the hms of&a CommunwmIM of Mammhusek.
101 This Agreement forms Me comp lite ANW-aled agneummq between Na and Dstonmr to pt rt represent art warimh that A execillsig is Agreement Me"im
not relying on anympnesmAboils wwrmies or Lima other Man as oWamAy contained mram.
and contractor and may not be altered Ibsent a alseTant written aTuarmast&ymd by boM parties.
You may caned Mh Agmanalt 10 has been Apul M a One Ohs than He NSL!nonmal p1me of bushms,provided you Na A nIq at I mAnihm,or
loww1mbn by ordinary m posk?4 ter lram mM or 4 dolvery,rN WW Man mAtil of the MAN&Aneu day holo wing Me syniny of IN Agreamor? _nee he
mf ache ff notice form for all explanation of Alls nghf.
1.ENERGY BENEFITS.
He Sponsoring URI ConT any No MOO is entded W MO%of the wrMy berwhN assaMd wAh I 11imp f,o rservation C leasures,exclidry the value of energy
cost Savings by it Cristomen bit htkwing all rights to all associaNd SOME 12mM&Elacry mW Reserves Pmhd&NSI agrees W javide Me MW At such fudhei
domimadstion as tie URI may request W umlin Ow Utility s ownerAo A such Ends arid Products.
12.NOTICE CONCERNING SPONSORSHIP,
Customer whasbinds and acknowledges let NSL is net an:,gent,vendor or sun vendor of Hm Slidsol ng Utility Compaq(he UHiky)with iespecl to tie Insiallaholl of
an energy offiamxy nrasurv&I Me event of be tit o of an ump imseruhm d0u)W perimm as e"edaj Mnlono 4 wle mmurse 0 0 Contractor amu not to
Consetv,tion Services Gtoup((,.)G)a to the Uhlily. 1-he NO and N yeraliq mistmijers Ad not mah5unnave or p&mn any work whatsoever on Me energy
conseilj,-Ilion measures tStt-dsd'
Customer unct-Astandsand acknowledge Umt Mex paikoahn in the Mass Sue Home BmW SmWas Nogram a vamby and ME they cansenk"m
C,'ontradoi to install the proposed energy conservation measures.
CoWmer agrees Mal A AW net MW CAG,the URI there aNatiss m quarnly companies liable for Canhadoit to pwfuln As dAgalims umhor It agreement,for
is A the energy roirservatrrm mea arca to ink,W my hmago W(AAmn's'remises earned by Gaitisdor a for-any and all&mqu to property w injury o
13.LIMITED TIME OFFER.
Me prices and inconhe Whi-ed in Mis Conhad an xNed to change A amwasm Wish to"onsoring URI conqpwry Mom Sue 1-home Energy make Program
offers.
14.CONTRACT CANCELLATION
Under Massachusetts law,you may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be
his main office or a branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by
delivery,not later than midnight of the third business day following the signing of this agreement.
Mass Save Planview Diagram
Customer C Y L Advisor Name:R, 6k,
Address 7X'L -V�QWLalJr�� V-4> Advisor Number:
Town_ 00A-V\ Ay\dcw-c Y- .Any limitationstruck?,_,
to access by truck?. ,
Site ID
NOTES
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The Comma niveaftb qfMassachasefis
Department ofIndustriW Accidents
9#11ce®f In Vesdgations
I Congress Street, Suite 100
Boston, HA 02114-2101cue v`o 7
n,m,mmasxgov1d&
Workers' Compensation Insurance Affldavftm BuRders/Contractors/E lectriclans/Plumbers
Applicant Information Please Print"e
Name (Busiricss/Organizationftdividual): Next Step Living
Address: 21 DrydockAve
,/State/7]p: Boston, MA 02210 Phone,M(866)66 -8729
Are you an employer? Check the appropriate boxoType of project(required):
F
I.N I am 9,employer with 860 Q. 1 am a general contractor and 1 6. n New construction(full and/or part-time).* have hired the sub-contractors 7� ®Remodeling
2.0 I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub-contractors have 8. E]Demolition
working for me in any capacity. employees and have workers' 9. E]Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. 0 We are a corporation and its 10.El Electrical repairs or additions
3. 1 am a homeowner doing all work officers have exercised their 11.®Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12f]Roof repairs
-insurance required.] t c. 152, §1(4)9 and we have no 13.X other Insulation
employees. fNo workers'
comp. insurance required.]
*Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information.
I lomeowners whe.submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidalit indicating such.
Coat-actors thai Bieck this box tn?ist attached an additional sheet showing the name of the sub-contractors and state whether or rot those entities have
have
employees, if the sub-contractors have employees,they must provide their workers'comp,policy miraber.
Ti am an employer thae is pr workers'compensadon insurancefor my employees. Below is the policy find job 400
A.I.M Mutual Insurance Company
Insurance Company Name:
Policy#or Self-ins. Lie.#:AWC-400-7U30025-2014A Expiration Date: 9/30/15
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisomneritt, as well as civil penalties in the form of a STOP WORK ORDER and a find
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
h-westigations of the DIA for insurance coverage
I d®hereby certify under the pains andpe ers ry that the information provided above is Prue ju me an correct.
Signature: C)
Phone
Of
,ricial use only. Do not write in this area,to be completed by city or town officiaL
City or Town- Permit/License #
Issuing Authority(circle one).
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone P'.
NEXTS-1 OP ID:EL
CERTIFICATE OF LIABILITY INSURANCE DAT E(MMIDDNYM
1010112014
THIS CERTIFICATE is issurm AS A MATTER OF INFORMATION Q"�Ly AND COWFE4%t4O RIGHT1 PPON THV MRTIFIGATP HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, QXI-END OR AQ TER THE COVERAGE Ar-FokDED BY THE POLIgIES
BEL . THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIMP
NTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDEP.
tUe��_isd� If_8UBROGAT1ON'Kq Rq
Sc �v ���
"P ' - T. N!_
IMP RTA DITI
ly t h�
coolf
h .0't' 10" lot
an alt"pa"J!""11.,n Imv a Fe 1 7 1; "1
cerlificAge hol&r!Fj IIGu of such andarseiment(s).
PRODUCER FNAMITEf ETUT OHS
MqLaughllrrt I suvanog Ayeacy PHONE FAII
028 Lynn felks! Parkwpy (All,No,1101:701-065-2775 (AIC,No):781-665-02qq
Melrose,MA OPWO E-MAIL
ADDRESS:
John E.McLaughlin Jr. INSURER(S)AmrORDING COVERAGE NAIC C
INSUPEV A;HEIUMUS InSLgr@1169
INSURED Maid stop�Iving'Inc. liqsUpcp 0:CommPree Insurance Company
21 Op
ydoch Avenue,2nd Moo)v lNSupERc:A.0A.Mutual Insurance Co.
Boston,MA 02210 INSURE D:AXIS Insurance Company 15610
INSURER E:
INSURER r:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PFRjp
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT T 118
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE IN$UPANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS or SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ITR_SR TYPEOFINSURANCE ADDL SUBP POLICY NUMBEP POLGVEFF POLICY E)P LIMITS
LTIR —W91 010 Imm2L=
A Y, COMMERCIAL GENERALLIABILITY EACH OCCURRENCE $ 1,000,000
To
CLAIMS-MADE MR]OCCUR PDRAMEMAI'SEES(EaEocrTuErDrence) $ jQ0,000
MED EXP(Any one person) 0,900
PEOSONAL to ADV INJURY 1,099,09
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE
POLICY FIPRO- LOC PRODUCTS-COMPIOP AGG
JECT F]
OTHER.
66P00 OWE LINT
AUTOMOBILE LIAGI(ITV (Ea accident)
ANY AUTO 09130/201,4 09/30/20-ij BODILY INJURY(Per person)
ALL OWNEDx SCHEDULED BODILY INJURY(Pei accident)
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS AUTOS Per accidentI
M_I,R r_LLA F, X OCCUR EACH OCCURRENCE
'R
D EXCESS LJAB _J�I:LAIMS.MADE Elt09/30/2014 AGGREGATE $
DIED I _]RETENTIONS - -..F-T —-1-1 STATUTE
ER
WORKERS COMX PCOMPENSATION -
ATU TE OT ER
AND EMPLOYERS'LIABILITY VIM
C ANY PROPRIETOR/PARTNER/EXECUTIVE N/A TO BE ISSUED BY CARPIER 09/3012014 001301-9015 E.L.EACH ACCIDENT $ 500,000
OFFICERWEMBER OCCLUDED? F] 500,000
(Mandatory in NN) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
_DESCRIPTION OF OPERATIONS belowE.L.DISEASE-POLICY LIMIT $ r09,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AC(ORD 101,Additional Renar%s Schedule,may be atlachod If more space is required)
FOR INFOEdEW-VION ON-Ty
CERTIFICATE HOLDER CANCELLATION
INFO-011
OHOUILO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOr, NOTICE WILL BE DELIVERED IN
r-ur Info rmUon Only ACCOVIFJA14CE WITH THE POUCY PROVISIONS.
AUT HORIZIED REPRIESENTAT IVE
1900-2014,ACORD CORPORPATIOK A91 rights 5wevved.
ACORrii 26(201�Iqj 1) A P ANON 4 mm RiA�P"'r, r�"qkhw,��mj qv A,C C,R�:-
�
I
Oifice 'of Consumer Affao r� and Business Regulation
10 Park Plaza - Spite 5170
Boston9 Massachusetts 02116
Home Improvement Contractor Registration
Registration: 162111
ype: Supplement Card
Expiration: 1/14/2017
ItiEXT STEP LIVING INC.
ROGER OUELLETTE
21 DRYDOCK AVE. 2TH FL
BOSTON, MA 0221
(Update Address and return card.Mark reason for changed
E] Address Ej Renewal n (Employment F] Lost Card
"w;
Office of Consumer Affairs&Business Regulation License or registration valid for individual use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
Ra?giotration. 162111 Type: 10 'ark Plaza�-Suite 51?D
Expiration: 1014/2017 Suppiemeni Care! Boston,MA 02 t 16
NEXT STEP LMNG IIVC.
ROGER OUEt.LE T TE
21 DRYDOCK AVE.2TH FL
BOSTON,MA 02210 t0udesse�retauy Not valid 3vithouut signature
h I V,,; p,;id t o�I, i( �`O �'l,i L,Q(t, b a
f 4"'i hJ
ROGR R A OVELLIT
MM
55 ST AI ORIZE
WUMCHK RR WSW
89§1312016
Rezideted To: CSSL=OC-lnSuk0On Contractor
Faflure to possess a current edition 09'the Massachusetts
State Building Code is cause for revocation COT this license.
For BPS UJUItIM06,9�-6n)VOPS